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  • 3 Feb 2018 12:09 PM | WSMTA (Administrator)

    Prior Authorization Bills

    Two bills have been submitted to the legislature regarding Prior Authorization.  They are both sponsored by the Physical Therapy Association of WA  (http://www.ptwa.org/) and the WA State Chiropractic Association. (www.chirohealth.org)

    SB 6157 - 2017-18


    Regarding prior authorization.

    Sponsors: Short, Kuderer, Rivers, Cleveland, Palumbo, Nelson, Becker, Walsh, Warnick, Van De Wege

    HB 2837 - 2017-18


    Regarding prior authorization.

    Sponsors: Kloba, Harris, Kirby, Robinson, Appleton, Johnson, Stonier, Dolan, Macri, Maycumber, Slatter, Stanford

    The Main part of the bill that will affect massage therapists is this:

    2)A health carrier may not require prior authorization for initial evaluation and management visit ((or an initial)) and up to eight consecutive treatment visits with a contracting provider in a new episode of care of chiropractic, physical therapy, occupational therapy, East Asian medicine, massage therapy, or speech and hearing therapies that meet the standards of medical necessity and are subject to quantitative treatment limits of the health plan.

    Notwithstanding RCW 48.43.515(5) this section may not be interpreted to limit the ability of a health plan to require a referral or prescription for therapies listed in this section.
    The first hearing was on Jan 30 in the Senate Committee on Health & Long Term Care at 10:00 AM   

    https://www.tvw.org/watch/?eventID=2018011418   (starting at 36:00). Please watch this to get a better idea of the issues as presented by the Physical Therapy Association.

    The main comment in opposition to the bill came from Meg Jones, of the The Association of Washington Healthcare Plans her comments were in relation to the potential problem of allowing more sessions which would increase costs of health care plans, which is not a good idea in the face of a unstable health insurance market.

    WSMTA suggests that you comment on the bills by going to the bill pages linked above and click on comment in the top right hand corner.  Comments should be focused on the main issues that affect client care, ie;  delay of treatment or loss of continuity of care, which are the main things the Office of the Insurance Commissioner and the Senate Committee are most concerned about.  You can post your comments and you also have the option to send them to your local representative. Focus on the efficacy of massage therapy and that they still will need a prescription in order to meet medical necessity massage therapy covered.  Note how delay in or denial of treatment may result in more opioids being prescribed.

    Also take notice of the representatives that have sponsored the bill.   They are representatives that are on the side of the massage profession and will need our support at election time.

    For more information on how a bill becomes a law see this  from the WA State Chiropractic Association - https://c.ymcdn.com/sites/chirohealth.site-ym.com/resource/resmgr/Files/2014_federal_regulations_WA_.pdf

  • 18 Nov 2017 2:18 AM | WSMTA (Administrator)

    WSMTA attended the recent Board of Massage Meeting where the main topic of discussion was on the topic of whether or not to increase the number of continuing education hours up from the 500 hour requirements.  500 hours has been the requirement since 1989. 

    WSMTA researched and discussed the issue at length and submitted the following to the Board of Massage Therapy

    WAC 246-830-430 Education -- Final.pdf

    State Massage Licensing.pdf

    Also submitted for consideration were these documents:

    WSMTA -- WAC 246-830 3 Yrs Clinic SupvrCE Ed Instructors Exp -- Final.pdf

    WSMTA--WAC 246-830-035 out-of-state applicants -- 3 year Gap -- Final.pdf

    WSMTA--WAC 246-830-035 out-of-state applicants -- Min Hours -- Final.pdf

    The next meeting of the Board of Massage is January 12, 2018 at

    Department of Labor & Industries
    7273 Linderson Way S.W., Room S-117
    Tumwater, WA 98501

    Please send your comments on your thoughts on the number of hours of education required for massage licensing to info@mywsmta.org and the Board of Massage therapy.  

    Megan Maxey
    Program Manager
    Washington State Board of Massage

    Department of Health Office of Health Professions

    P: (360) 236-4945 | E: megan.maxey@doh.wa.gov

  • 27 Oct 2017 7:12 PM | WSMTA (Administrator)

    This is the latest email from the Board of Massage answering some questions on the new rules.

    Dear Interested Parties:

     Attached for your reference are some of frequently asked questions we have received on the new and amended rules to chapter 246-830 WAC – Massage Practitioners.

     More information can be found on the massage therapist webpage.

     Please contact us if you have any questions. Thank you and have a great weekend.

     Megan Maxey

    Program Manager

    Washington State Board of Massage


    P: (360) 236-4945 | F: (360) 236-2901

    megan.maxey@doh.wa.gov | www.doh.wa.gov


    The Department of Health works with others to protect and improve the health of all people in Washington State.

    DOH logo

  • 18 Oct 2017 11:05 AM | WSMTA (Administrator)

    Notes on the "A Commitment to Value" Conference

    (Day 1: Purchaser Conference)

    by the Health Care Authority

    On October 18, 2017, the Health Care Authority hosted a 2-day conference aimed at Payers/Producers, Purchasers/Employers and Providers regarding "Value-Based Purchasing".  If you didn't know, the Health Care Authority (HCA) is the WA State government organization that purchases health care services for medicaid (Washington Apple Health) and PEBB (Public Employees Benefits Board), which makes it the largest purchaser of health insurance in WA State.  They spend roughly $10 billion a year.  Their contracts with producers/payers is available online, with redactions for confidentiality.

    Currently, our health care is based on "fee for service", the provider is paid for each procedure performed.  This can create over treatment or evaluation as providers earn more money by performing procedures.  Medicare has been pushing the healthcare industry to switch to "Value-Based Purchasing".  In Medicare speak, this means adding payment from the value added to care of patients by improving measurable outcomes.  When Medicare implemented this, hospitals reported metrics and received additional payment for medicare patients for high or positively improving metrics.  Some aspects of the healthcare chain in different geographic regions of the United States have taken this concept and run with it to create "integrated care systems" that go beyond their own medical organizations to provide "value-based care".

    Value-based purchasing, is about purchasing insurance plans that provide medical service that improve the value of the health care by determining a correct diagnosis, plan of care and follow through to make sure the patient is managed through the system in a way that solely benefits the patient and reduces unnecessary care that can be both expensive and harmful.  An example of this is how doctors and clinics are now treating diabetes patients.  Instead of the patient showing up for an annual checkup, providers within the organization regularly follow up with the patient with diabetes to make sure that their A1C numbers and other indicators are staying within normal ranges throughout the year, providing opportunities for education on managing a lifestyle that reduces variability in daily glucose readings, arranging for check-ins with pharmacists to ensure the type of medication being used remains effective and is being correctly used.

    The Conference organizers brought in large and small purchasers to present and also had producers/payors participate as well.  Day 1 was meant to provide education on value added purchasing, perspectives from a variety of participants with an eye towards creating some solutions between payers/producers and purchasers.   Day 2 was meant to create small groups to try and brainstorm solutions to some of the issues.


    The following sections are snippets from the various presenters.


    Sim Grants -- The State Innovation Models (SIM) initiative provides federal grants to states, under cooperative agreements, to design and test innovative, state-based multi-payer health care delivery and payment systems. The distinctive purpose of the SIM initiative is to test whether new models with potential to improve care and lower costs in Medicare, Medicaid, and CHIP will produce better results when implemented in the context of a state-sponsored plan that involves multiple payers, broader state innovation, and larger health system transformation to improve population health.2 A premise of the SIM initiative is that states have important policy and regulatory authorities and the ability to convene a broad array of public and private stakeholders – means that can be used to leverage the development of initiatives in which multiple payers participate, potentially enhancing their effectiveness. -- verbatim  https://www.kff.org/medicaid/fact-sheet/the-state-innovation-models-sim-program-an-overview/ -- Note:  only roughly 1/2 of the states participated.


    Resources Purchasers should use in order to make wise choices in the plans they choose or help to create:

    • Community Checkup -- rates clinics, medical groups and hospitals -- https://www.wacommunitycheckup.org/

    • Bree Collaborative -- The Dr. Robert Bree Collaborative (Bree) was established in 2011 by the Washington State Legislature.  

    “…to provide a mechanism through which public and private health care stakeholders can work together to improve quality, health outcomes, and cost effectiveness of care in Washington State.”

    Information about our legislative authority can be found in the bill that established the Bree.  Members are appointed by the Governor and include public health care purchasers for Washington State, private health care purchasers (employers and union trusts), health plans, physicians and other health care providers, hospitals, and quality improvement organizations.  Verbatim from website.  http://www.breecollaborative.org/

    • WA State Common Measures Committee -- Legislative Language:  ESHB2572, Section 6 "there is created a performance measures committee, the purpose of which is to identify and recommend standard statewide measures of health performance to inform public and private health care purchasers and to  propose benchmarks to track costs and improvements in health outcomes -- verbatim from slide 7 http://crhn.org/pages/wp-content/uploads/2015/06/Common-Measure-Set-Release-12-08-2015_FINAL-DRAFT_PDF-for-review.pdf.  The direct link is: https://www.hca.wa.gov/about-hca/healthier-washington/performance-measures.


    Consumerism is the primary driver for improvement in goods & services:  

    • Consumer Directed Healthcare -- By allowing patients to control and manage their own health care dollars, consumer-directed health plans help individuals become more conscientious consumers of health care.  Consumers are able to shop around, compare prices and providers, and select the medical services that are best for them.  Doctors are able to repackage and reprice their services, competing for patients based  on price and quality.  -- verbatim http://www.ncpa.org/about-cdhc/

    • castlighthealth.com  -- Castlight connects with thousands of health vendors, benefits resources, and plan designs. Through our partner ecosystem, you can purchase pre-integrated vendors on a single contract. But you're not limited to our ecosystem—we can create truly seamless user experiences with nearly any vendor, utilizing our flexible integration architecture. -- verbatim  https://www.castlighthealth.com/

    • accountable care organizations -- ACOs are groups of doctors, hospitals and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.  The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. -- verbatim https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html.  WA state has ACOs that are not medicare related, such as the UW Medicine Accountable Care Network.


    John Espinola, MD, aka "Espy" is the Executive Vice President, Healthcare Services, Premera Blue Cross:  In his talk "Espy" put forth the idea that change requires time.  Annual health plans as they exist may not be able to accomplish change in the most "timely" or effective way as they are reactive to the whims of regulatory, payer and purchaser organizations.  Perhaps, there could be an alternative method to having an "annual" plan.

    Julie Sylvester, Vice President, Business Development, Virginia Mason:   Health care is a complicated thing to explain at the member level, let alone the purchaser level.  Terms are not always easily translated.  Need to make it easy for the purchaser to understand.  Messaging is key.


    Community-based organizations will be key in getting info to the public.

    Providers are using social workers to help manage high risk patients in their community.


    From Karen Wren, Benefits Manager, Point B (approximately 1400 employees):  If you are a smaller employer:

    • talk directly to the producer -- get educated, find out how to manage your plan, what tools you need to do so.

    • find out from the producer how your employees are using their benefits.  Figure out how to improve the quality of care or provide knowledge of how to use benefits more effectively to improve care and reduce the employer costs.  For example, if your employees are using the ER a lot, find out why and educate them on alternative options if the ER really isn't an appropriate choice.

    • find out if it's possible to work with payors/producers to mirror the state's health plan for smaller purchasers.

    As a smaller company, if you create a self-funded program for your employees, you can use existing organizations to manage your needs instead of getting rejected by the insurance companies because you're too small.  Here are some options that Option B uses:

    • RxBenefits:  Small and mid-sized companies lack the negotiating clout to wrangle competitive pharmacy contracts.  But not with us.  We leverage our collective database for deeper discounts, smarter terms and more significant savings.  All supported by our high-touch service model.  -- verbatim www.rxbenefits.org

    • CarrumHealth:  Carrum Health directly connects progressive self-insured employers to top-quality regional healthcare providers through the industry's first comprehensive bundled payment solution.  Our innovative platform reimagines how care is paid for and delivered, improving the value of health benefits for employers and their members. -- verbatim  currumhealth.com

    • "Choosing Wisely Campaign" -- "Choosing Wisely" aims to promote conversations between clinicians and patients by helping patients choose care that is:

    • supported by evidence

    • not duplicative of other tests or procedures already received

    • free from harm

    • truly necessary

    In response to this challenge, national organizations representing medical specialists asked their providers to "choose wisely" by identifying tests or procedures commonly used in their field whose necessity should be questioned and discussed.  The resulting lists of “Things Providers and Patients Should Question”  are intended to spark discussion about the need--or lack thereof--for many frequently ordered tests or treatments. -- verbatim  www.choosingwisely.org -- there is more to it than this, but you can go to the website to find out more.


    Susie Dade, Deputy Director, Washington Health Alliance

    Washington Health Alliance --  The Washington Health Alliance services to build a strong to alliance among patients, doctors, hospitals, purchasers, health plans and others to promote health and improve quality and affordability by reducing overuse, underuse and misuse of health care services. -- verbatim www.wahealthalliance.org

    Seven things every purchasing executive should know about the problems with healthcare:

    • health care quality varies widely

    • significant portions of healthcare spending is waste -- 30% ($1 trillion is wasted every year)

    • no provider is good at everything

    • financial incentive are misaligned

    • businesses generally buy health care based on cost

    • wellness programs are important but not sufficient

    Seven things you can do about it:

    • understand your data (know what works, who has successful outcomes, etc)

    • focus on value, not just cost

    • demand transparency of information (metrics, etc)

    • insist on value in contracting

    • manage your healthcare costs like the rest of your supply chain

    • educate your employees

    • Build momentum and join with other purchasers to drive change.


    Center of Excellence (COE):  ACOs and other health care networks are identifying and creating "centers of excellence" were the quality of care and outcome of procedures is high -- and predictable.  Within a plan, if you choose a COE, then the expense might either be lower or there might be no cost (after deductible) and if you choose to go elsewhere the expense will be at a set rate.  

    An ACO (Accountable Care Organization) is supposed to be the accumulation of the best of medical care in certain areas by bringing together organizations and providers that offer integrated services.  These are put together through the analyzing of the quality and outcomes of care with the thought of cherry picking what is available to create great health care.  From the producer/payor standpoint, they've worked hard to provide affordable and quality care but the general public views this is as narrow options, a limitation of choice.  Producers/payers want to work with purchasers to figure out how to bridge this gap of education for members to buy in that these networks are in the member's best interests.


    David Lansky, PhD, CEO, Pacific Business Group on Health.

    Pacific Business Group on Health:  Rapid and complex changes are occurring in healthcare, creating unprecedented opportunities for purchases of healthcare services to come together and drive improvements in quality and affordability.  PBGH is a purchaser-only coalition, representing 60 public and private organizations across the US that collectively spend $40 billion a year purchasing healthcare services for 10 million Americans.  PBGH functions as a convener, administrator and advocate for dramatic change and delivers value to its Members in the following ways:

    • Implementing practical purchasing programs that return value.

    • Providing access to a network of like-situated professionals.

    • Convening Health Plan User Groups to address plan-specific issues and organizing Work Groups to tackle current issues.

    • Building platforms for the public release of cost and quality information so Members can form value-based networks.

    • Advocating with both national and state policymakers.

    • Disseminating timely information and alerts via newsletters, webinars, Twitter feeds and a Member-only LinkedIn Group and web portal.

    -- verbatim  http://www.pbgh.org/

    Good News:  David mentioned in his speech that Payers/Producers, Purchasers/Employers and Providers coming to together like this is leading edge, that there are very few geographic locations in the US that are trying to work together like WA state is.

    Bad News:  He also mentioned that he heard a quote from the expected, soon-to-be new secretary of health (whose name I did not catch, if it was mentioned) who stated something to the effect that he only believed in "fee for service" health care and that value-added purchasing was a waste of money.

  • 15 Sep 2017 9:55 AM | WSMTA (Administrator)

    The September 8, 2017 Washington State Board of Massage (BOM) meeting was held in Spokane, WA.  The primary two topics for discussion by the board was the "Rules Workshop" and the "Application For Approval of a Transfer Program".

    Rules Workshop

    On July 30, 2017, the last round of rule making changes that the Board of Massage had approved went into effect and become published WACs that all massage therapists must now obey.  During this first rule making process, the Board of Massage decided to shelve several topics for a future round of rule making and to reopen several other topics for further discussion and definition at the same time.  In order to reopen the rules, a new CR-101 had to be filed with the state.  This will be the second round of the rule making.


    The CR-101 is a Preproposal Statement of Inquiry, which gives the public notice that the agency is considering developing a new rule, amending an existing rule, or repealing an entire rule or sections of a rule. This allows the public an opportunity to participate in the rule making process at an early stage.  In order to create a CR-101, the AMTA-WA submitted a petition requesting a CR-101 based on those topics discussed at prior Board of Massage meetings and the BOM approved the creation of a CR-101 at the 7/7/17 Board of Massage meeting held via conference call.  The new CR-101 was filed on 9/7/17.

    Essentially the new CR-101 covers the following topics:

    • education and training requirements (of massage schools)
    • continue education requirements
    • updating the perineal and breast massage rules to make the consent to treat language uniform and to define what the "perineal area" means
    • recordkeeping, record retention and ownership of records.

    At the September 8 meeting, after some discussion the Board of Massage decided to schedule the 2018 meetings and then schedule when each topic was planned to be discussed.  The list of meetings and rule discussions is:

    • November 17, 2017 Kent -- Massage School Education and Training Requirements
    • January 12, 2018Tumwater -- Massage School Education and Training Requirements/Transfer Program
    • March 9, 2018Kent -- Continuing Education/Tools
    • May 11, 2018 Yakima -- Perineal/Breast Language
    • July 13, 2018Vancouver -- Perineal/Breast language
    • September 14, 2018 Spokane -- Recordkeeping
    • November 2, 2018 Tumwater -- TBD

    The end goal was to be able to process the next CR-102 and CR-103 by the end of the year 2018 or by the beginning of 2019.  The CR-102 and CR-103 is the process by which the public becomes involved and WACs are created/amended.  The BOM decided that having a scheduled processed would aid in helping to reach the end goal and help interested parties to organize their efforts.

    No rules were discussed at this meeting.  It was essentially a planning meeting around the rules process.  The public commentary section was added back to the agenda, so many useful comments were made by the public to the Board about a variety of topics.

    Application For Approval of a Transfer Program

    With the legislative approval in early 2017 of new law to create a transfer program to permit massage schools to accept students from other programs (schools from out of state, from other local schools, students who have a background in another health profession like nursing for example who want to transfer credits from a college or university).  WAC 246-830-037 Transfer programs and transfer of prior education and clock hours was created as part of the prior rule making processes and went into effect on 7/30/17 and defines the transfer process.  However, up until now, the Department of Health hasn't had an application or process by which to approve schools who want to have a transfer program.  Up until now, the Department of Health has allowed transfer students to apply for licensure under the old system.  To help the process along, the Department of Health created a new application form and presented it to the Board of Massage for approval.  The BOM approved it.  The BOM and Department of Health representatives at the meeting settled on a process of requiring massage schools who already have a transfer program to submit their application by 11/15/17 and applications would be reviewed and approved/denied at a special conference call meeting to be held on 12/15/17.  Massage Schools who wish to create a transfer program either could also submit applications by 11/15/17 or at a future time.

    Human Trafficking Taskforce Update

    Lilia Lopez, who is the Assistant Attorney General to the Board of Massage is being replaced by another AAG whose name I did not catch.  The new AAG had a discussion with Farshad Talebi, from the Attorney General’s Seattle office. Mr. Talebi is the AGO’s specialist in human trafficking issues here in Washington.

    The new AAG stated that there were approximately 400 storefronts offering massage that are on the Human Trafficking Taskforce's radar in Washington State.  He mentioned that they were highly mobile and could close and set up shop easily.  The taskforce has decided that a way they can deal with these "illegitimate massage businesses" (IMB's) was to inform landlords that they could be charged with a crime by renting to organizations who do illegal businesses and perpetrate crimes on the premises.  It was thought that this way they might be able to reduce the IMBs abilities to offer illegitimate massage to the general public.

     The Board requested that the new AAG arrange for a specialist on this topic to provide an educational session at one of the future BOM meetings to help educate the board members on the situation.

    Written by Robbin Blake

  • 7 Jul 2017 10:27 AM | WSMTA (Administrator)

    Report from the State of WA Board of Massage July 7 2017 Board meeting

    The most important part of the BOM meeting was the discussion of…does the board want to begin another round of Rule writing, and if so, which Rules do they want to look at.

    During the last Rule writing, the board had “tabled” rules around…educational requirements for licensure as well as continuing education, because they felt that they needed more time to research what might be needed, as far as changes, and they did not want to “delay” the other rules that were moving through the process. Also, during the very end of the last round of Rules writing, the Board discovered some “gaps” that they wanted to go back and possibly fill. Ultimately the Board tabled any decisions about which Rules to work on until their meeting in Sept. But here are some highlights of the discussion that happened…

    1. Education for licensure. All past discussions have been in regard to following the Entry Level Analysis Project (ELAP) www.elapmassage.org.  It was again discussed to use this as the jumping off point.
    2. Continuing education. Most of the Board felt that some clean up and clarification of language needed to happen vs. changing the number of hours required. Because LMTs have a 2 years cycle for CEs, if new Rules are written the effective date would need to be 2 years from adoption to allow for compliance (during those 2 years the Board would not be able to touch those Rules).
    3. Are more specific educational requirement need to go along with the new Rules around Breast Massage and Perineal Area Massage? Possibly, is the short answer.  One Board member suggested a need for Perineal area massage to have an Endorsement (like Intra-oral). Executive Director, Blake Maresh, reminded the Board that they do not have statutory authority to require an endorsement. It would require legislation to give them the authority to require an endorsement for this type of work.

    “Thanks to Robbin Blake who provided me with notes from the second half of the meeting which I had to miss.”

  • 25 Apr 2017 10:24 AM | WSMTA (Administrator)

    Report from DOH Board of Massage Rules (WACs) hearing on April 25 2017

    The Board of Massage began this particular rule writing process in August of 2014! The reasons for this lengthy and arduous  undertaking was to…clarify, streamline and modernize the rule language, to make sure that current best practices with regards to public health and safety are reflected in the rules and to comply with several pieces of legislation. The Board is on track to have these rules become effective July1 2017.

    The process during the meeting was as follows…

    1. Written comments that had been received by the board were available to the board members to review and were also available to those attending the meeting.

    2. Verbal comments were taken from anyone present that wished to provide comment.

    3. Comments that were received by staff after the cut off were also provided to board members.

    At this point the public comment period ended and the board began their deliberation of the proposed rules and the comments received.

    The bottom line is… not much, of substance, was changed from the last draft of the proposed rules.

    One area that had lots of discussion was around consent. Consent is called for in several sections of rule…Scope of Practice-Limitations, breast massage, draping and record keeping, all of the those section will have the same language for consent. The requirement will be “signed, written and verbal informed consent”. It was helpful to listen to the board deliberate this one because it gives us guidance as to how they will interpret this in disciplinary cases.

    Here is what I heard…All clients/patients must give signed written consent forms on file to have a massage, they should separately (can be on the same form) give consent for breast massage and then every session that you do breast massage with that client/patient you will make sure to get additional verbal consent and note that in your charting. Same goes for perineal massage and for variations in draping. There is one complicating factor thought, when the board members described what they though “informed” meant they used phrases like educating/communicating to your clients/patients about what you will do and why, making sure they understand what they are agreeing to. But, the medical profession as a much more detailed definition of “informed” and there are many medical malpractice lawsuits that revolve around what is “informed” consent and what is not. So we will have to see how this plays out.

    The other area where there were lots of written comments was recordkeeping. The board stood firm with the proposed language. They felt strongly that this level of documentation is necessary to protect the health and safety of the public and by allowing for documentation to be “appropriate to the venue” that the burden to the provider will not be greater than the benefit to the public’s health and safety.

    The proposed language currently reads:

    WAC 246-830-565


    (1)A massage practitioner providing professional services to a client or patient, must document services provided. Documentation should be appropriate to the venue, the type and complexity of those services, and in sufficient detail to support and enable anticipated continuity of care. The documentation must include:

    (a)Client or patient name and contact information;

    (b)Health history sufficient to ascertain if there are cautions or contraindications to safe application of massage therapy, and an update of the current health status at each session;

    (c)Date massage therapy is provided and the duration of treatment;

    (d)The types of techniques and modalities applied;

    (e)The location or areas of the body that received massage therapy;

    (f)Written consent to treat;

    (g)If breast massage is performed, an additional written consentt o treat per WAC 246-830-555, and documentation of a therapeutic rationale;

    (h)If breast massage of the nipples and areolas are involved,

    documentation of the prescription or referral per WAC 246-830-555

    (3)(a), or an additional written consent to treat per WAC 246-830-555

    (3)(b);(i)Documentation of any written consent or any modification in draping as required by WAC 246-830-560; and(j)For massage therapy where the focus is on treating a healthcondition, the following additional information is required:

    (i)Symptoms, for example, pain, loss of function, and muscle stiffness;

    (ii)Evaluation and findings, for example, movement, posture,palpation assessment and findings;

    (iii)Outcome measures, for example, improvement in symptoms,movement, posture, palpation, and function; and

    (iv)Treatment plan for future sessions.

    (2)Client or patient records must be legible, permanent, and recorded within twenty-four hours of treatment. Documentation that is

    not recorded on the date of service must designate both the date of service and the date of the chart note entry. Corrections or additions

    to the client’s or patient’s records must be corrected by a single line drawn through the text and initialed so the original entry re


    mains legible. In the case of computer-organized documentation, unintended entries may be identified and corrected, but must not be deleted from the record once the record is signed and completed or locked. Errors in spelling and grammar may be corrected and deleted.

    (3)Correspondence relating to any referrals concerning the evaluation or treatment of the client or patient must be retained in the

    client or patient record.

    (4)Client or patient records should clearly identify the massage practitioner who is the provider of services by name and signature or electronic signature and date of service.

    So the board voted to approve the proposed rules as amended in today’s meeting. These rules will now go the Secretary of Health. He can approve them as is or he can make modification. Once the Secretary approves the rules he will send them to the Code Reviser to be filed and they will become effective 30 days after that.

    So where does this leave us… with lots of question to be sure. Even the board recognized that it is impossible to write perfect rules; rules always have gaps, limitation, inconsistencies and a multitude of interpretations. Once the rules are finalized the board can revisit them and create some guidelines and interpretations (an informal process) that will help us all to be able to follow the letter of the law.

    Oh, and we are not done yet! The board hopes to start the rule writing/revision process again later this year with the rules around curriculum, training and continuing education!

    You can read the latest version of the rules in their complete form here.1707113massagetherapypractic102final  PDF  (as accessed from the DOH Website on April 24, 2017)

  • 5 Nov 2016 10:21 AM | WSMTA (Administrator)

    Updates from a very short (2hrs.) Washington State Dept.

           of Health Board of Massage meeting (11/4/2016)

    School program review:  NW Academy for the Healing Arts, a deficiency letter was sent.

    Day Spa Academy (Spanish Program), Approved

    Therapeutic Connections School of Massage, Approved

    Allied Health Careers Academy, Approval was removed

    Policy review: The board reviewed three of their internal policies. The most discussion was around the policy for…Initial and Re-Approval of Massage Schools/Program and Site Reviews. Specifically the issue of retroactive approval or re-approval is what the board discussed. The board has put off any final determinations until more information can be gathered but this is the way they are “leaning” so far. No retroactive approval will be available to new schools/programs. With regards to re-approval they are leaning toward a short grace period (30-90 days) for schools/programs. Renewal notices go out 90 days prior to expiration (just like for our massage license renewals), then the school would have some number of extra days to complete their re-approval process and be able to get that re-approval to be retroactive to the day the approval expired. This is to safe guard any students that might graduate from the school during the time that their schools approval is technically expired. Once the retroactive re-approval is in place that student would be eligible to sit for the licensing exam. There was also a suggestion that schools be required to disclose to students the expiration date of their approval.

    Jurisdiction Review and Standards for Model Board Member Conduct Policies…just received formatting corrections.

    Meeting dates and locations for 2017: January 13 Kent, WA; March 17 Tumwater, WA; May 19 Tumwater, WA; July 14 Vancouver ,WA; September 8 Spokane, WA; November 17 Kent, WA. It was also discussed that it is VERY likely that a “special meeting” will be called in February after the Rules hearing.

    Elections: Reynaldo Guajardo LMP was re-elected to the Chair position and Anthony Sharpe, Public Member was re-elected to the Vice-chair position.

    Program Reports: Revenue…it is too early to see what affect the fee increase (Oct. 1 2016) will have in easing the bottom line for the massage programs budget.

    Rules: The draft of the rules…has gone to the  DOH attorneys to make sure there are no violations of other  state laws in the draft language and to DOH staff to assess if there is any undue economic burden to LMPs in implementation of the rules. All a standard part of the process.

    Report from Federation of State Massage Therapy Boards (FSMTB) Annual Conference. FSMTB has 44 members now and 41-42 were present at the conference.  It was reported that every state is having issues around human trafficking and illegal massage businesses. There were two different proposals to limit the number of attempts at passing the Mblex. Nothing was passed but it was discussed that for PTs they get 3 attempts to pass then they must take remedial education then they have three more attempts. After that no more attempts are allowed.

    A new (old) board member was appointed, Meghann Lawrence will return to the massage board in January 2017 after a year’s absence. She will fill the position left by Nancy Allen who has completed two terms. Thank you Nancy for your service to the profession.

  • 15 Jul 2016 10:19 AM | WSMTA (Administrator)

    WA State Board of Massage Meeting Report – July 8, 2016

    Posted on July 15, 2016

    WA State Board of Massage ReportReport from Washington State Board of Massage Meeting – July 8 2016

    Marybeth Berney,  WSMTA President.

    Two Directors on the WSMTA Board (Marybeth Berney and Amy Thomason) attended the morning portion of this meeting on behalf of WSMTA members. This is the report from that meeting…..

    First I will say that neither Amy nor I were able to attend the May meeting, but it became apparent very early on in this meeting that the May meeting must have really gone “sideways”. Buy this I mean, it sounds like the Board and staff had difficulty controlling the audience and keeping the meeting on track.

    After the Board approved the Consent agenda (item 1), Blake Maresh, Executive Director for the Board of Massage, gave a presentation on the “Open Public Meeting Act”. As a side note, the power point slides that he used during this presentation were just sent out to the Massage Board LISTSERVE last week, so they may be in your inbox. Here are the highlights…

    Open Public Meeting Act-Chapter 42.30 RCW, was first enacted in 1971. It states that committees, commissions and boards exist to aid in the conduct of the public’s business and that deliberations are to be conducted openly. However, the chapter also says…that those who interrupt or disrupt a meeting can be asked or directed to leave, if this does not restore order the room can be cleared. The meeting can be rescheduled or can continue without an audience.

    The bottom line is: the OPMA guarantees your right to attend and observe, but not to interfere or disrupt. Mr. Maresh was very clear; he wants the public and the profession to be a part of these meetings, provided they can observe the proper decorum. I was a member of the state massage board for 7 years. The rule writing process is arduous, time consuming and very important to the profession. There is no mandate that rules development happen in a public board meeting. The profession has been allowed into the development process because the board and staff thought we could be of help! These board members are volunteers giving freely of their time and expertise and it pains me greatly that some of my fellow practitioners would not treat them with the respect they deserve. Please, it is important that the profession be allowed to participate. If you cannot behave properly/professionally then do not attend.

    Agenda item number 4 was the Credentialing Report. Joanne Miller reported that 93% of massage license applications are being processed within 9.5 days. The new Education Endorsement form is working well and they are making some updates to the Animal and Intraoral application. The Facilities Credentialing division is drafting a new school application. All of the info from the previous application will be there, plus a few standardized questions that exist across all health facilities. This will allow for massage training programs to be added to the health facilities database, allowing for some additional tracking of data and metrics.

    Agenda item number 5 was an update on the, Online Licensing Portal. It is currently being tested with about 8 professions (none are massage). Eventually all health professions and 5 types of health facilities will use this portal for licensing and renewal. This portal will allow for more information gathering across all health professions.

    Board of Health Rule Making Process

    That brought us to agenda item 6…another presentation by Executive Director Blake Maresh on the Rulemaking Process. Here are the highlights…

    The Dept. of Health (DOH) in conjunction with the Board opened chapter 246-830-Massage Practitioner in 2014. This chapter has not had a comprehensive review since its adoption in the early 1990’s. RCW 43.70.041, enacted in 2013 in response to a legislative directive requires a comprehensive review every 5 years.

    The goal of rulemaking is to…clarify, streamline and modernize the rules governing massage in WA…protect and improve the health of all people in WA (This is the purpose of the DOH and all health Boards, Commissions and Committees)…make sure that only individuals who meet and maintain minimum standards of competence and conduct are allowed to provide massage services to the public.

    The Rule Development Process starts when the DOH files a CR-101-notification of intent to do rule writing. This form is used to notify stakeholder of the subject(s) to be reviewed and why rules on this subject(s) may be needed and how interested parties can participate.

    Rule development workshops. The board has held 12 rules workshops as part of board meetings, while this is not required under the Administrative Procedures Act (APA, chapter 34.05 WAC) this has allowed the board to engage with members of the public/profession in the earliest stage. When the board feels that they have a solid draft they will direct staff to file a CR-102 (Proposed Rule Making) with the Office of the Code Reviser. A CR-102 has not been filed yet. The board has chosen to review ALL the massage WACs in a “lump”. The board could decide to move ALL of these rules forward under a single CR-102 or they could decide to just move certain rules forward and hold some back to continue to work on the language of those rules. Once they file a CR-102 we will know what rules will move forward at this time and which, if any, they may choose to continue to work on and bring forward with a separate CR-102.

    Once the CR-102 is filed a 6 month clock starts to tick. During this time the DOH provides interested parties an opportunity to submit formal comments on the proposed rules, either in person at public hearings or in writing or online. At the conclusion of the public comment period the DOH will consider all comments received and must file the final adopted rule language with the Office of the Code Advisor. This is done with the publication of the Rule-Making Order (CR-103) form.

    There are many things the board must take into account with rule writing that are sort of “hidden”. They must attempt to mitigate the costs to small businesses of implementing the rules; they must demonstrate that the rules will have benefits that out way the cost of implementation, they must show that they are not arbitrarily limiting market participation. In other words they have to make a solid case for why and how these rules will protect the public.

    Here is a summary of changes so far…

    • Transfer of Training hrs. HB 2781 required the board to write rules to allow board approved programs to develop programs that allow students to transfer credits earned in a non-board approved massage program.
    • Breast massage, this sets guidelines and requirements for doing breast massage.
    • Draping, sets guidelines and requirements for proper draping.
    • Record keeping, requires all massage practitioners to document treatment.
    • Licensure by endorsement, provides a pathway for WA licensure for MTs licensed in other jurisdictions.
    • Training, increases training hours to 625 and makes student clinic mandatory.
    • Continuing education, makes CPR and First Aid a requirement for renewal and requires an individual teaching to have a minimum of three years’ experience in the subject they are teaching.

    Now remember all of this is draft. The board has yet to authorize the staff to file the CR-102 on any of these rules, so we are not even in the formal comment period yet.

    If you would like to observe, the next WA State Board of Massage meeting is Sept. 8 in Spokane WA and the final meeting of the year is Nov. 4 in Olympia. If you are not on the State Board of Massage LISTSERVE…get on there. It is your duty to yourself, your clients/patients and your profession to keep abreast of what changes are coming down the pike.


    Marybeth Berney

    WSMTA President

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